The medical school curriculum is famously vast. The best approach to distilling the volume of information required for learning and retention during the pre-clinical years is highly individualized.
Still, the options for study resources continue to go beyond those offered within the traditional curriculum, and with that, the manner in which students grow their knowledge base has evolved. The 2022 Association of American Medical Colleges Year 2 survey reported that approximately 70% of students used non–institution-created online videos and other online content daily or weekly for medical education information.
Third-party study resources such as Uworld, Pathoma, Sketchy Medical and AMBOSS are becoming increasingly popular to augment or replace traditional medical school learning modalities. A qualitative study of preclerkship medical students’ attitudes about these resources, published in JAMA Network Open, found that students tout them for their concision, clarity and efficiency.
For medical students trying to master the pre-clinical years of medical school, what are the pros and cons of third-party resources? Dhruv Puri, an AMA member medical student who excelled in that part of his training, offered insight on the value of third-party study resources.
Pro: Third-party resources emphasize active recall
Puri found that while in-person lectures may plant the seed of knowledge, reinforcing that information with third-party resources is how it most effectively grew.
“We know that active-recall methodology works better than anything else,” said Puri, a medical student at the University of California, San Diego, School of Medicine, “And lectures are not necessarily active recall, but doing these practice questions and visual resources online, doing these flashcards, that’s all active recall. It’s the most efficient and effective way to learn.”
As a first-year medical student, Puri relied heavily on third-party resources to supplement in-person and recorded lectures.
“If I would run into something in a lecture that wasn’t clicking for me, I had those third-party resources to fall back on,” said Puri, who is currently taking a research year in urology between his M3 and M4 years of medical school. “I found that the initial encoding, that initial lecture was only the first step of getting that information in my head.”
Puri’s experience aligns with the study’s findings. Among the main reasons study participants cited for using third-party resources: highlighting knowledge gaps, memorization, repetition, and highlighting the most important content.
Con: Third-party resources can be costly
Third-party resources are expensive, and that expense can be incurred on top of medical school tuition, boarding and food.
The JAMA Network Open study, which drew upon focus groups conducted with a total of 58 medical students, found that “participants commented on resource cost compared with medical school tuition given their belief that most, if not all, students were using third-party resources. Some participants attended school lectures to justify tuition costs. Participants wished their institutions would facilitate the subscription process, pay for or subsidize third-party resource costs.”
Pro: Third-party resources are tailored to Step 1
The key milestone for pre-clinical medical students—the event toward which the curriculum builds—is Step 1 of the United States Medical Licensing Examination (USMLE) series.
As Puri progressed from an M1 to an M2 and began to prepare for USMLE Step 1 exam, third-party resources became more and more prevalent in his studying. It’s also worth noting that Puri was in the first full class of medical students to take the exam pass-fail.
“A big revelation my classmates and I came to is that there’s a threshold of knowledge needed to pass the exam,” he said. “What we realized is that if you thoroughly complete and learn Pathoma and Sketchy, specifically the material relating to pathophysiology, microbiology and pharmacology, that’s enough to comfortably pass Step 1. These resources gave us a baseline of what were expected to know, and it helped establish that baseline in a time-efficient manner.”
The JAMA Network Open study also highlighted that “participants desired customized learning materials, often emphasizing the importance of alignment with USMLE Step examinations.”
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Con: There are a lot of third-party resources to choose from
“These resources can be overwhelming,” Puri said. “There’s a lot of them out there and I’ve seen students become overwhelmed or do more than is necessary because of that. Rather than picking one or two, they try to do everything.”
When selecting resources, he said there’s usually institutional knowledge that is passed down from one class of students to the next. Puri highlighted Pathoma and Boards and Beyond as resources that can augment material that is covered in lectures.
Con: They may not help with pre-clinical exams
While each school is different, and many have moved to a pass-fail system of grading in the pre-clinical years, certain courses in your pre-clinical track are likely to require a final exam. Third-party resources are heavily geared toward board exams. Because of that, they might not touch on key areas of material that were covered during in house lecture.
Student respondents to the JAMA Network Open study offered that it would be beneficial for schools to better integrate the resources into the curriculum when possible.
“Maybe these resources are emphasizing something that isn’t aligned in your lecture,” Puri said. “I’d also point out sometimes in your pre-clinical life you are learning things that aren’t as clinically relevant. Priorities and the focus of your studying shift as you go from preclinical years to clinical years. It is a tough balance to achieve.”
